自我管理综合技能训练对精神分裂症患者康复及幸福感与自尊的影响

目的：观察自我管理综合技能训练对精神分裂症患者康复疗效及幸福感与自尊的影响。方法选取2012‐02—2013‐04我科治疗的精神分裂症患者112例为研究对象,采用随机数表法分成观察组、对照组。对照组行精神科常规护理,观察组在对照组基础上行自我管理综合技能训练。采用住院患者观察量表（NOSIE）、简明精神病评定量表（BPRS）、总体幸福感量表（GWB）及自尊量表（SES）于治疗前与治疗3个月后对患者进行评价。结果观察组治疗后社会能力、个人卫生、社会兴趣等积极方面评分明显高于对照组,差异有统计学意义（P＜0.05）;观察组治疗后抑郁、退缩、激惹等消极方面评分明显低于对照组,差异有统计学意义（P＜0.05）;观察组治疗后精神症状评分低于对照组,但差异无统计学意义（P＞0.05）。观察组BPRS干预后评分明显低于对照组,差异有统计学意义（P＜0.05）;观察组GWB、SES干预后评分明显高于对照组,差异有统计学意义（P＜0.05）。结论自我管理综合技能训练可明显提高精神分裂症患者的幸福感和自尊,是一种有效的治疗方式。     

自我管理训练联合家属教育对精神分裂症患者治疗依从性及复发率的影响

目的探讨自我管理训练联合家属教育对精神分裂症患者治疗依从性及复发的影响。方法选择2014年1~12月在我院治疗的精神分裂症患者132例及每位患者主要的家庭照顾者1名共132名为研究对象,按随机数字表格法将上述患者分为干预组和对照组,每组各66例。对照组仅给予常规的入院健康教育,干预组对患者进行自我管理训练,对家属进行相关知识教育。比较两组的临床疗效、复发率、治疗依从性等。结果两组干预前阴性和阳性症状量表(PANSS)评分,组间比较差异无统计学意义(P0.05)。治疗6个月及12个月后,干预组阴性和阳性症状评分显著低于干预前,差异有统计学意义(P0.05),并且干预组评分显著低于对照组(P0.05)。对照组在治疗6个月时PANSS评分较干预前下降(P0.05),但是在治疗12个月时恢复到入组水平(P0.05)。干预6个月及12个月后,干预组患者的治疗依从性显著高于对照组,差异有统计学意义(P0.05)。在干预实施12个月时,干预组的病情复发率显著低于对照组,差异有统计学意义(P0.05)。结论自我管理训练联合家属教育能够更有效地改善精神分裂症患者的预后,提高治疗依从性结果降低复发率。     

综合干预对社区精神分裂症患者社会功能的影响

目的:探讨综合干预对社区稳定期精神分裂症患者社会功能的影响。方法:采用整群随机抽样方法,将256例精神分裂症患者随机分为干预组133例和对照组123例。干预组在原有药物治疗的基础上进行药物自我管理、症状自我监控、回归社会技能训练和家庭健康教育等综合干预,对照组予单纯药物治疗。分别在干预前、干预3、12个月后进行阳性和阴性症状量表(PANSS)、个人和社会表现量表(PSP)评定。结果:干预前两组PANSS、PSP评分差异无统计学意义;干预3个月,干预组PANSS评分明显低于对照组(P0.05或P0.01);干预12个月,干预组PSP评分明显高于对照组(P0.01)。结论:在药物治疗的基础上,综合干预能够有效改善稳定期社区精神分裂症患者的社会功能。     

齐拉西酮联合心理干预在青少年精神分裂症中的应用效果

目的探讨齐拉西酮联合心理干预在青少年精神分裂症中的临床疗效。方法选取2014年1月~2016年12月医院收治青少年精神分裂症患者90例,随机分为对照组(n=45)和观察组(n=45)。对照组采用齐拉西酮治疗,观察组在对照组的基础上联合心理干预治疗,采用阳性和阴性症状量表(PANSS)对两组治疗效果进行评估。结果观察组治疗后有效率为94.1%,对照组为67.6%,两组差异有统计学意义(P0.05);治疗后,观察组治疗后阳性量表、阴性量表、一般病理及量表总分均低于对照组(P0.05)。结论青少年精神分裂症患者在齐拉西酮基础上联合心理干预治疗效果理想,值得推广应用。     

意念与模仿行为训练对精神分裂症患者的效果

目的 探讨意念与模仿行为训练对精神分裂症患者的效果.方法 选择2017年7月～2020年7月期间招募的80例精神分裂症患者为研究对象,按随机数字表法分为对照组和研究组,各40例.对照组采取药物治疗,研究组在对照组的基础上联合意念与模仿行为训练,比较两组的阳性与阴性症状、生活质量以及认知功能.结果 两组治疗前阳性阴性症状量表(PANSS)、生活质量量表(SQLS)评分差异无统计学意义(P＞0.05),治疗后PANSS评分显著降低,SQLS评分逐渐升高,治疗后研究组PANSS评分显著低于对照组,SQLS评分显著高于对照组(P＜0.05);两组治疗后MCCB量表各项评分均显著降低,且治疗后研究组认知功能成套测验(MCCB)量表各项评分均低于对照组(P＜0.05).结论 意念与模仿行为训练有助于降低患者阳性与阴性症状,提升生活质量,并改善认知功能.     

职业劳动技能训练对慢性精神分裂症患者生活质量的影响

目的 探讨职业劳动技能训练对慢性精神分裂症患者生活质量的影响.方法 142例住院慢性精神分裂症患者随机分为研究组和对照组各71例,共脱落15例.两组患者均在药物治疗的基础上,参加简单工娱治疗,研究组增加职业劳动技能训练项目.实验前后采用护士用住院病人观察量表(NOSIE)、阳性与阴性症状量表(PANSS)、生活质量评定综合问卷(GQOLI — 74)评估临床疗效和生活质量.结果 入组时NOSIE、PANSS、GQOLI — 74评分两组间比较差异无统计学意义(P＞0.05);结束时NOSIE总积极因素、总消极因素及病情总估计分值改善程度大于对照组,差异有统计学意义(P＜0.01);PANSS总分、阴性症状分、一般精神病理量表分改善程度大于对照组,差异有统计学意义(P＜0.01);GQOLI评分中心理功能、社会功能2个功能维度分改善程度大于对照组,差异有统计学意义(P＜0.01).结论 职业劳动技能训练可以改善慢性精神分裂症患者的社会功能,从而提高生活质量.     

强化无错性节奏训练治疗稳定期精神分裂症患者疗效的研究

目的研究稳定期精神分裂症患者在药物治疗基础上经强化无错性节奏训练治疗12周后,临床症状、生活质量的变化。方法纳入稳定期精神分裂症患者90例,随机分为治疗组(n=45)和对照组(n=45)。在药物治疗种类、剂量不变基础上,治疗组给予强化无错性节奏训练,对照组无其他干预,共12周。分别于基线及干预12周末,采用阳性与阴性症状量表(positive and negative symptom scale,PANSS)评估临床症状,精神分裂症患者生活质量量表(schizophrenia quality of life scale,SQLS)评估生活质量,功能大体评定量表(global assessment function,GAF)评估社会功能。结果基线时两组间各量表及其分量表评分差异均无统计学意义(P0.05)。重复测量方差分析示PANSS总分、阴性症状、一般精神病理症状、反应缺乏、思维障碍、偏执、抑郁评分及SQLS中心理社会、动力和精力评分的分组与时间交互效应有统计学意义(P0.05),而GAF评分交互效应无统计学意义(P0.05)。简单效应分析提示治疗结束时PANSS总分、阴性症状分、一般精神病理症状、反应缺乏、偏执、抑郁评分及SQLS中心理社会、动力和精力评分在治疗组下降具有统计学意义(P0.01),而在对照组变化无统计学意义(P0.05)。结论强化无错性节奏训练可有效改善稳定期精神分裂症患者缺陷症状及生活质量。     

心理干预治疗对缓解期精神分裂症的作用

目的探讨精神分裂症患者缓解期应用抗精神病药物联合心理干预治疗的临床疗效及对患者生活质量、社会功能的影响。方法选取123例缓解期精神分裂症患者,随机分为观察组61例,对照组62例。观察组在给予药物治疗的同时联合心理干预治疗,每周进行1次心理干预治疗;对照组只应用药物治疗,观察8周,并随访6个月。治疗前后应用阳性与阴性症状量表(PANSS)、社会功能缺陷筛选量表(SDSS)、世界卫生组织生活质量量表(WHOQOL-100)进行评估。结果入组时PANSS、WHOQOL-100及SDSS评分组间比较差异均无统计学意义(P0.05);随访结束时,观察组PANSS总分、阴性症状、阳性症状和SDSS评分均显著低于对照组(P0.01);WHOQOL-100中社会关系领域评分、独立性领域、生活质量总评分均较对照组高(P0.05或0.01)。结论心理干预治疗缓解期精神病分裂症患者效果显著,患者精神情况、生活品质以及社会功能均显著提高。     

社区康复训练对慢性精神分裂症患者的效果观察

目的探讨社区康复训练对慢性精神分裂症患者的效果。方法选取我社区慢性精神分裂症患者92例,根据完全随机化原则将其分为对照组和干预组,每组各46例。其中对照组患者给予常规抗精神分裂症药物治疗,干预组在此基础上给予社区康复训练。6个月后观察比较两组患者阳性和阴性症状量表(PANSS)、自知力与治疗态度问卷(ITAQ)、社会功能缺陷筛选量表(SDSS)评分。结果两组患者干预前PANSS、ITAQ与SDSS评分比较,差异均无统计学意义(P0.05)。干预后,干预组PANSS阳性量表、阴性量表、一般精神病理量表评分及总分、ITAQ与SDSS评分改善情况均优于对照组;且与同组干预前比较,以上评分均明显改善,差异均具有统计学意义(P0.05);而对照组以上评分无明显变化,差异无统计学意义(P0.05)。结论社区康复训练可明显改善慢性精神分裂症患者的症状,增强患者自知力和社会功能,促进其康复。     

计算机化认知训练对慢性住院精神分裂症患者认知功能的影响

目的 探讨计算机化认知训练对慢性精神分裂症患者认知功能的影响.方法 采用随机对照研究,将80例慢性精神分裂症患者分为两组,每组40例,均服用抗精神病药维持治疗.研究组患者在使用药物治疗的同时合并计算机化认知训练(干预6周),对照组患者单纯使用药物治疗.采用阳性与阴性症状评定量表(PANSS)和精神分裂症认知功能成套测验(MCCB)在干预前后评定患者的精神症状和认知功能.结果 经过计算机化认知训练后,研究组的MCCB中工作记忆训练分与对照组比较改善明显,差异有统计学意义(P＜0.05),而MCCB中其他项目分及PANSS评分改善不明显,差异无统计学意义(P＞0.05).结论 计算机化认知训练能够改善慢性精神分裂症患者的认知功能,尤其表现在工作记忆上.     

Epilepsy and anomalies of neuronal migration: MRI and clinical aspects

Neuronal migration disorders are the result of disturbed brain development. In such disorders, neurons are abnormally located. In diagnosing these conditions, magnetic resonance imaging is superior to any other imaging technique. This enables us to improve our knowledge of the clinical correlates of neuronal migration. With reference to migrational disorder, a retrospective study of all 303 patients with epileptic seizures referred for magnetic resonance imaging during a 3-year period was performed, 13 patients (aged 12-41, mean age 27) were identified. They represent 4.3% of the entire study group. Of the patients with known epilepsy, 6.7% and of the mentally retarded, 13.7% had migrational disorders. Four patients had schizencephaly as the dominant finding, one was classified as hemimegalencephaly, 2 had isolated heterotopias, and 6 had localized pachy- and/or poly-microgyria. The clinical pictures are complex. Ectopias of grey matter are recognised foci of epilepsy, but from an epileptological and a clinical viewpoint little attention has been given to these disorders. The present study shows that malmigration is not rare in epilepsy patients, especially not in the mentally retarded.     

Classification of methods in transcranial Electrical Stimulation (tES) and evolving strategy from historical approaches to contemporary innovations

Transcranial Electrical Stimulation (tES) encompasses all methods of non-invasive current application to the brain used in research and clinical practice. We present the first comprehensive and technical review, explaining the evolution of tES in both terminology and dosage over the past 100 years of research to present day. Current transcranial Pulsed Current Stimulation (tPCS) approaches such as Cranial Electrotherapy Stimulation (CES) descended from Electrosleep (ES) through Cranial Electro-stimulation Therapy (CET), Transcerebral Electrotherapy (TCET), and NeuroElectric Therapy (NET) while others like Transcutaneous Cranial Electrical Stimulation (TCES) descended from Electroanesthesia (EA) through Limoge, and Interferential Stimulation. Prior to a contemporary resurgence in interest, variations of transcranial Direct Current Stimulation were explored intermittently, including Polarizing current, Galvanic Vestibular Stimulation (GVS), and Transcranial Micropolarization. The development of these approaches alongside Electroconvulsive Therapy (ECT) and pharmacological developments are considered. Both the roots and unique features of contemporary approaches such as transcranial Alternating Current Stimulation (tACS) and transcranial Random Noise Stimulation (tRNS) are discussed. Trends and incremental developments in electrode montage and waveform spanning decades are presented leading to the present day. Commercial devices, seminal conferences, and regulatory decisions are noted. We conclude with six rules on how increasing medical and technological sophistication may now be leveraged for broader success and adoption of tES.     

Hepatic Considerations in the Use of Antiepileptic Drugs

Summary: Virtually all of the major antiepileptic drugs (AEDs) can cause hepatotoxicity, although fatal hepatic reactions are rare. The mechanisms, incidences, and risk profiles for such reactions differ from drug to drug. With carbamazepine and phenytoin, hepatotoxicity may be due to drug hypersensitivity. Although the profiles of patients at risk have not been well-defined for these two antiepileptic drugs, it would appear from reports in the literature that older adolescents and adults are at higher risk than children of developing serious or fatal hepatotoxicity. Once hepatotoxicity develops, mortality rates are 10–38% with phenytoin and 25% for carbamazepine. The risk profile for valproate fatal hepatotoxicity has been more clearly defined. Those at primary risk of fatal hepatic dysfunction are children under the age of 2 years who are receiving multiple anticonvulsants and also have significant medical problems in addition to severe epilepsy. The risk is considerably lower for patients over the age of 2 years on valproate monotherapy. In contrast to the risk profile with other AEDs, adults receiving valproate as monotherapy have the lowest risk of hepatotoxicity. Fatal hepatic dysfunction coincident with valproate may be the result of aberrant drug metabolism. Concomitant use of AEDs that induce microsomal P450 enzymes (e.g., phenytoin and phenobarbital) may enhance the production of a toxic metabolite, and hence the greater risk of hepatotoxicity with polypharmacy.     

Vascular Malformations and Epilepsy: Clinical Considerations and Basic Mechanisms

Summary: Vascular malformations (VMs) are associated with epilepsy. The natural history of the various VMs, clinical presentation, and tendency to provoke epilepsy determine treatment strategies. Investigations have probed the mechanisms of epileptogenesis associated with these lesions. Electrophysiologic changes are associated with epileptogenic cortex adjacent to VMs. Putative pathophysiologic mechanisms of epileptogenesis include neuronal cell loss, glial proliferation and abnormal glial physiology, altered neurotransmitter levels, free radical formation, and aberrant second messenger physiology.     

Neonatal Seizures: Problems in Diagnosis and Classification

Summary: The clinical identification of neonatal seizures is critical for the recognition of brain dysfunction; however, diagnosis is often difficult because of the poorly organized and varied nature of these behaviors. Current classification systems are limited in their ability to communicate motor, autonomic, and electroencephalo-graphic features of seizures precisely and to provide a basis for uniform effective diagnosis, therapy, and determination of prognosis. Recent investigations of neonates, utilizing bedside electroencephalographic/polygraphic/ video monitoring techniques, have provided the basis for improved diagnosis and classification of seizures in the newborn. These studies have demonstrated that not all clinical phenomena currently considered to be seizures require electrocortical epileptiform activity for their initiation or elaboration. In addition, the specific clinical character of the phenomena considered to be seizures, the clinical state of the infant, and the character of the EEG indicate the probable pathophysiological mechanisms involved and suggest probable etiologies, prognosis, and therapy. Similarities between animal models that demonstrate reflex physiology and neonates with motor automatisms and tonic posturing suggest that these clinical behaviors may not be epileptic in origin but, rather, primitive movements of progression and posture mediated by brainstem mechanisms. Although not all clinical behaviors currently considered to be neonatal seizures may have similar pathophysiological mechanisms, they are clinically significant because they all indicate brain dysfunction.     

Valproate Monotherapy in the Management of Generalized and Partial Seizures

Summary: For decades, therapeutic tradition has promoted the concept of polypharmacy in the management of epilepsy. In recent years, however, studies have shown that, for most patients, monotherapy can provide comparable or better seizure control than administration of multiple anticonvulsants, while diminishing the potential for adverse reactions, drug interactions, and poor compliance. Valproate is an important monotherapeutic agent that is highly effective in the control of idiopathic primary and secondarily generalized epilepsies, and partial seizures that do not generalize. Comparative studies have found that valproate is at least as effective as phenytoin and carbamazepine in the treatment of generalized and partial seizures. Given the similar efficacy, other factors such as pharmacokinetics and side effects may therefore determine anticonvulsant selection for monotherapy.     

Carbamazepine Efficacy and Utilization in Children

Summary: Carbamazepine is effective for preventing partial and generalized tonic-clonic seizures in children. Although absence epilepsies are more common in children than adults, an estimated 80% of children with epilepsy have seizure types or epilepsies that are potentially responsive to carbamazepine. The differential diagnosis of ictal staring is an especially important issue in children because absence and atypical absence seizures are more prevalent in children than adults. Age-related pharmacokinetic differences and drug interactions are major considerations in children. On average, children have higher clearance rates of carbamazepine, shorter half-lives, and higher ratios of carbamazepine-10, 11-epoxide to carbamazepine than adults. In addition, children with severe epilepsy are more likely to require multiple-drug therapy, which can lead to complex drug interactions. When carbamazepine is administered along with valproate, drug protein binding interactions can cause intermittent side effects.     

Un nouveau cadre conceptuel de travail pour la psychiatrie

In an attempt to place psychiatric thinking and the training of future psychiatrists more centrally into the context of modern biology, the author outlines the beginnings of a new intellectual framework for psychiatry that derives from current biological thinking about the relationship of mind to brain. The purpose of this framework is twofold. First, it is designed to emphasize that the professional requirements for future psychiatrists will demand a greater knowledge of the structure and functioning of the brain than is currently available in most training programs. Second, it is designed to illustrate that the unique domain which psychiatry occupies within academic medicine, the analysis of the interaction between social and biological determinants of behavior, can best be studied by also having a full understanding of the biological components of behavior.